Consolidated billing tip: Understainding "Provided Under Arrangements"

Nov 22, 2019
The Bottom Line

Any services subject to SNF CB must either be furnished directly by the SNF with its own resources or furnished under arrangement. “Provided under arrangements” means that the SNF has an agreement with the provider of the services. The SNF should have a valid agreement in place, written or verbal, with all providers of services or supplies to a Part A resident. It is strongly recommended, but not required, that SNFs have a written contract in place with the outside vendor to avoid conflicts later.

CMS will not get involved with the contracts between SNFs and other providers but does offer the following guidelines of responsibility for each party.

SNF requirements:

  • Must bill Medicare on the Part A claim for items included in CB
  • Must pay the supplier for those services
  • Must make a good-faith effort to inform suppliers of a beneficiary’s Part A status
  • May not bill the family privately for the items

Vendor requirements:

  • Suppliers should make an effort to determine whether patients are in a Part A SNF stay
  • Suppliers must bill SNFs on a timely basis
  • Suppliers cannot bill either Medicare Part B or the family privately for services that should beincluded on the Part A SNF claim

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